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A rational approach to uninvestigated dyspepsia in primary care: review of the literature

¹ Regional Public Health Laboratory, Groningen/Drenthe
² Department of Gastroenterology, Bethesda Hospital, Hoogeveen
³ Department of Gastroenterology, University Hospital, Groningen, The Netherlands

Correspondence to:
Correspondence to:
Dr J C Thijs, Bethesda Hospital, Dr G H Amshoffweg 1, 7909 AA Hoogeveen, The Netherlands;
n.l.a.arents{at}mmb.azg.nl

In this paper the rationale and limitations of the four most important approach strategies to dyspepsia in primary care (empiric treatment, prompt endoscopy, "test-and-scope", and "test-and-treat") are analysed. It is concluded that in the absence of alarm symptoms, a "test-and-treat" approach is currently the most rational approach provided that three conditions are met: (1) a highly accurate test should be used, (2) the prevalence of Helicobacter pylori in the population should not be too low, and (3) an effective anti-H pylori regimen should be prescribed taking sufficient time to instruct and motivate the patient.

Keywords: dyspepsia; Helicobacter pylori; test-and-treat; endoscopy

Abbreviations: GORD, gastro-oesophageal reflux disease; NSAID, non-steroidal anti-inflammatory drug

This article has been cited by other articles:

				N. L. A. Arents, J. C. Thijs, A. A. van Zwet, M. Oudkerk Pool, J.-M. Gotz, G. T. van de Werf, K. Reenders, W. J. Sluiter, and J. H. Kleibeuker Approach to Treatment of Dyspepsia in Primary Care: A Randomized Trial Comparing "Test-and-Treat" With Prompt Endoscopy Arch Intern Med, July 14, 2003; 163(13): 1606 - 1612. [Abstract] [Full Text] [PDF]